Dosing and uses of Cefoxitin
Adult dosage forms and strengths
powder for injection
- 1g
- 2g
- 10g
Uncomplicated Infections
1 g IV q6-8hr; 3-4 g/day maximum
Moderate-Severe Infections
1 g IV q4hr or 2 g IV q6-8hr; 6-8 g/day maximum
Gas Gangrene
Infections commonly requiring antibiotics in higher dosage
2 g IV q4hr or 3 g IV q6hr; 12 g/day maximum
Surgery Prophylaxis
Prevention of infection
Colorectal, non-perforated appendectomy, hysterectomy: 1-2 g IV
Ruptured viscus: 1-2 g IV q6hr
Renal Impairment
CrCl 30-50 mL/min: 1-2 g q8-12hr
CrCl 10-30 mL/min: 1-2 g q12-24hr
CrCl 5-9 mL/min: 500 mg-1 g q24-28hr
CrCl <5 mL/min: 500 mg-1 g q24-48hr
Other Indications & Uses
Bacteroides spp., Clostridium spp., Enterobacter, E. coli, H. influenzae, Klebsiella spp., Peptococcus spp., Peptostreptococcus spp., Proteus mirabilis, S. aureus, S. pneumoniae, group A beta-hemolytic Streptococcus
Pediatric dosage forms and strengths
powder for injection
- 1g
- 2g
- 10g
Infections
<3 months old: Safety & efficacy not established
>3 months old: 80-160 mg/kg/day IV divided q4-6hr; higher dosages should be used for more severe or serious infections
Surgery Prophylaxis
Prevention of infection
30-40 mg/kg 30-60 minutes before surgery
30-40 mg/kg q6hr for 24 hours afterwards
Renal Impairment
Adjust similar to adult adjustment
Geriatric dosage forms and strengths
Uncomplicated infections
1 g IV q6-8hr; 3-4 g/day maximum
Moderate-severe infections
1 g IV q4hr or 2 g IV q6-8hr; 6-8 g/day maximum
Gas gangrene
Infections commonly requiring antibiotics in higher dosage
2 g IV q4hr or 3 g IV q6hr; 12 g/day maximum
Surgery prophylaxis
Prevention of infection
Colorectal, non-perforated appendectomy, hysterectomy: 1-2 g IV
Ruptured viscus: 1-2 g IV q6hr
Cefoxitin adverse (side) effects
1-10%
Diarrhea
<1%
Anemia
Eosinophilia
Transient leukopenia
Thrombocytopenia
SCr & BUN increased
Elevated LFT's
Warnings
Contraindications (additional)
Documented hypersensitivity
Neonate (<3 mo)
Cautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections, and promotion of non-susceptible organisms may occur with prolonged use or repeated therapy
Pregnancy and lactation
Pregnancy category: B
Lactation: excreted in low concentrations in breast milk, use caution (AAP Committee states compatible w/ nursing)
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Cefoxitin
Mechanism of action
Second-generation cephalosporin with activity against some gram-positive cocci, gram-negative rod infections, and anaerobic bacteria. Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins; inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death
Pharmacokinetics
Half-Life: 45-60 min
Peak Plasma Time: 20-30 min (IM); within 5 min (IV)
Protein Bound: 65-79%
Distribution: Widely distributed to body tissues & fluids, including pleural, synovial, ascitic fluid, bile, poor CSF penetration
Excretion: Unchanged in urine (85%)
Administration
IV Incompatibilities
Additive: ranitidine
Y-site: cisatracurium(?, comp at low cisatra conc [0.1 mg/mL]), fenoldopam, filgrastim, gatifloxacin, hetastarch, pentamidine, vancomycin(?)
IV Compatibilities
Solution: compatible w/ most common solvents
Additive: amikacin, aztreonam, cimetidine, clindamycin, gentamicin, kanamycin, metronidazole, metronidazole w/ NaHCO3, multivitamins, NaHCO3, tobramycin, verapamil, Vit B/C
Syringe: heparin
Y-site (partial list): acyclovir, amphotericin B cholesteryl SO4, aztreonam, diltiazem, fluconazole, linezolid, MgSO4, morphine sulfate, ondansetron, propofoL
IV Preparation
Intermittent IV: reconstitute 1or 2 g w/ 10-20 mL SWI
Continuous infusion: add reconstituted soln to D5W or Ns
IM Preparation
Reconstitute by adding 2 mL SWI or 0.5-1% lidocaine HCl injection (without epinephrine) to each g of cefoxitin to obtain an approx 400 mg/mL solution
IV Administration
Injection: directly into a vein over 3-5-min or slowly into tubing of a compatible IV infusion solution
IM Administration
Deep into a large muscle (eg, upper outer quadrant of gluteus maximus)
